Objectives
To describe understandings that mothers and midwives have of ethnicity. To explore barriers to the successful implementation of ethnicity screening questions for sickle cell/thalassaemia.
Design
Observation of 121 first antenatal interviews between midwife and mother in four contrasting areas of sickle cell prevalence in England. Taped interviews with 111 mothers and 115 taped interviews with 61 different midwives. Fieldwork data from 76 preparatory workshops and liaison meetings.
Results
'Ethnicity' and 'family' are terms liable to variable interpretation. Both midwives and mothers implied belief in distinct 'racial' groups, disrupting scientifically accurate understandings of the relation between risk of sickle cell/thalassaemia and ethnic/family origins. Bookings were characterised by time pressures and a lack of explanation of sickle cell/thalassaemia. The mother was not permitted to self-assign ethnicity in 13 of 115 observed encounters.
Conclusions
Antenatal screening for sickle cell/thalassaemia based on an ethnicity screening question is weakened by a range of factors. Some midwives use intuition to select/exclude clients from the screening questions rather than implement formal policy. The screening term 'ethnic/family origins' is vulnerable to varied interpretations by clients. The persistence of erroneous beliefs in 'racial' groups displaces correct understandings of the relation between ethnicity and risk of carrying genes associated with sickle cell/thalassaemia. Midwives require support in both in ethnicity awareness and knowledge of sickle cell and thalassaemia, and more time at antenatal bookings to administer the ethnicity screening question. A challenge to the continued prevalence of scientific racism in popular discourse is required.

en

dc.description.sponsorship

The NHS Sickle Cell and Thalassaemia Screening Programme, Department of Health and the Unit for the Social Study of Thalassaemia and Sickle Cell